Regression of intracranial meningioma following intratumoral hemorrhage

An intratumoral hemorrhage within a meningioma occurs infrequently; in less than 3% of all lesions. When hemorrhage does occur, however, it is associated with a poor prognosis and significant mortality rates. We report a 66-year-old woman with a 10-year history of multiple intracranial meningiomas managed conservatively who underwent surgical resection of a spheno-orbital lesion for decompression of the right optic nerve. Postoperatively, an intratumoral hemorrhage developed in a contralateral lesion, which was managed conservatively. During follow up, the hemorrhaged lesion became significantly smaller. To our knowledge there are no published reports of spontaneous resolution of a meningioma after intratumoral hemorrhage without surgical management. We review the literature on hemorrhage in meningiomas and postulate some pathophysiologic mechanisms for the bleeding and subsequent tumor resolution seen in this patient.